Basic Information
| Provider Information | |||||||||
| NPI: | 1245283282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADKINS | ||||||||
| FirstName: | CLINTON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 WESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598402345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063632211 | ||||||||
| FaxNumber: | 4063754590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 WESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598402345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063632211 | ||||||||
| FaxNumber: | 4063754590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 10379 | MT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1245283282 | 05 | MT | MEDICAID | 1245283282 | 05 | ID | MEDICAID | 1245283282 | 05 | WA | MEDICAID |